Temporarily parked on the hard shoulder of life

Last weekend I was unable to bring you my blog due to being ensconced in a cottage in Scotland that had no internet access. It is strange how unthinking we become in our assumption that we will always be able to communicate with whoever, whenever and wherever we happen to be. Knowing that I was going to struggle to communicate once at the cottage, I had meant to send out a blog on Friday morning, but events overtook me and before I knew it the opportunity was gone.

This was unfortunate as I wanted to congratulate all my colleagues working at Greater Manchester West Mental Health Trust on their achievement of an Excellence rating on both the quality and financial management criteria in the recently published Care Quality Commission Performance tables. I am not keen on performance tables as a way of driving up organizational performance, but given that only 15% of all Trusts nationally achieved an Excellence rating for quality and 26% for financial management, the achievement of GMW is simply awesome – and well deserved.

Staying in a cottage in Scotland, isolated and disconnected, in itself reduces the inspiration for writing a blog. I can tell you about the otters, tame pheasants, and spectacular sunsets and so on. These were all wonderful distractions. However, within 24 hours of getting there I succumbed to a cold, which has, ‘gone to my chest’ as my Mother would say, and ever since I have suffered with a racking cough, fever, sleepless nights and so on. The consequence has been a lack of energy to get on and do what I would normally be doing! My inability to get going I found difficult. I could not concentrate to read, I didn’t put pen to paper at all, and even gave up shouting at the radio like the grumpy old man I can be when I hear something outrageous.

Finding myself temporarily on the hard shoulder of life has been a difficult place to be.

A balancing factor in this uncharacteristic week for me, was hearing the very sad news of my colleague Professor Deborah Bakers untimely death. Her contribution to improving our understanding of what makes for good health and wellbeing is internationally recognized. On a personal level she provided me with great support and enthusiasm. I shall miss her wise words and capacity for thinking differently. My thoughts are with Deborah’s family at this very difficult time.

Willie Nelson and Rod Stewart come together for the nurse genome project: Ob-la di, Ob-la-da – life goes on

Yesterday was the last day of the first Cochrane Nursing Care Network. The day started with a inspirational presentation from Alison Kitson, who now works at the University of Adelaide, although, of course she has a strong track record of innovative work in nurse education in the UK. What made her presentation interesting for me was that it was an update on where the International Learning Collaborative had got to; looking at what we understand the fundamentals of nursing to be. This is not new work, nor is it innovative. In the UK, the essential skills cluster initiative was aimed at ensuring the fundamentals of nursing were embedded into the curriculum, and similar initiatives can be found in the US, Australia and beyond. The collaborative were modeling themselves on the Human Genome project approach where scientists from all over the world worked collaboratively at trying to understand and unravel the big questions of human life. The collaborative are adopting a systematic review approach, the first stage of which was a meta-narrative analysis of what key texts (from Florence Nightingale onwards) to see what key terms were evident. This stage of the work had thrown up a number of terms that has then been tested out in data bases such a Medline and CINAHL to see what published studies would be highlighted. Intriguingly, there were many differences in the way these fundamental terms (elimination, activities of daily living, safety, communication and so on) were used in nursing theoretical and research based papers. Whilst this is very much work in progress, it was a fascinating update. The rest of the day was spent in workshops looking at how nurses could become more involved in the CNCN project. There were some easy wins to consider, particularly as some of these could fit into our preparation for the 2013 REF.

In the evening I went to eat at one of the many riverside restaurants and bars that have live music. I joined a table with a wonderful Singaporean family, who thought I was Willie Nelson, despite my protests to the contrary. We agreed a kind of truce, I think I admitted I may have once owned a Willie Nelson LP, and we got on and enjoyed a Beatles celebration night. The live band were very good, the music extremely familiar and in the end, we were all singing along – which was a sound to behold. The father of the family group was an expert on the Beatles and got all the pop quiz answers right, although he was equally impressed that I knew Alex Ferguson (he stated his allegiance to Manchester United rather than Liverpool!). It was a little difficult really to have a straightforward conversation as outside of the Beatles lyrics no ones English was easy to understand. The taxi driver on the way home was convinced I was Rod Stewart – something to do with the hair – couldn’t see it myself.

Anyway, tomorrow is a day off, and then it back to the mountain of emails, and a long return journey home to Manchester and the start of what promises to be a busy few days of work – as Paul, Ringo, John and George might have said Ob-la di, Ob-la-da – life goes on!

World Mental Health Day, Cochrane Nursing Care Network and the Lost Thursday

The news this week has been full of reports of Psychiatrists paying people diagnosed with a serious mental illness £15 each time they agree to have their medication via a injection, those suffering with Alzheimer’s Disease reported to being kept quiet and submissiveness through the use of a chemical straight jacket, and three suicides amongst young people, three of which are three too many. All of this has occurred during the lead up to World Mental Health Day (9th October). As a Professor in Mental Health Care I can’t emphasize enough the important of mental well being, and as Head of School that prepares people to become mental health nurses, I would iterate the importance of our students and staff looking after their own mental health and well being so they can then better enable those who ultimately seek their help back on to the road of recovery.

As I write this I am attending the inaugural Cochrane Nursing Care Network in Singapore. Interestingly nurses are the biggest group of health care professionals (including all types of medical staff) to access the Cochrane Library for evident to underpin their practice and delivery of care. Whilst the concept of a Cochrane Review is predicated on RCT’s and largely big quantitative type studies, the importance of the Nursing Care Network is the realization that we need to use these approaches more effectively in order to better demonstrate the efficacy of our interventions and the power of our knowledge base in shaping future health care services. There are over a 100 delegates to this event and a further 600 attending the more general Cochrane Colloquium that follows. The theme for this latter event is increasing the involvement of service users in the development of the evidence based Cochrane Library.

The missing Thursday – well I got up at 05.00am on Wednesday and started work in my office at 6am. After a day spent at a special session of Senate I got on a plane to fly to Singapore. By the time I got to my hotel room some 33 hours had passed, 20 of which were Thursday. However, coming back next Tuesday, I leave after breakfast Tuesday morning and get into Manchester in time for a late evening meal, still on Tuesday. It’s a strange world at times.

Conflict, Commercial Reasoning and the Appearance of Cello

Perhaps like me you found the Little Ted case disturbing. As a parent I can empathise with the parents involved. As a nurse with a research interest in the impact on adults of child abuse I can imagine the fears and anxieties of those parents whose children attended Little Ted's. I think it will take some time for the parents to accept that their children are safe. The case perhaps highlights the fragile sense of safety we construct when we see our children left to be cared for by others. Another disturbing aspect of the case, and there were too many to discuss here, was the knowledge that once Vanessa George has served her sentence, she is entitled to a life free from vigilante attacks or intrusion by the media – The Telegraph, this weekend estimated that this was likely to cost the tax payer £1 million a year. Like some of the parents, I found this information a little unpalatable.

This week I also heard from a colleague who had recently been involved in taking a decision about the future of an employee in his organisation which was to be based upon something called sound commercial reasoning. In a nutshell, this apparently refers to when an organisation has to consider the cost of say fighting a claim for constructive dismal versus the cost of fighting the case or where simply to ‘get rid’ of an individual it is worth agreeing a price for them to go. This seemed an equally unpalatable set of consequences.

The issues in both these situations reminded me of the somewhat old fashioned notion of the psychological contract – (see David Guest’s work – what is the value of the psychological contract?) - whilst this notion generally refers to the unspoken but powerful dynamics that bind individuals to an organisation, its vision and culture and the consequences for the individual and the organisations when this trust is abused. Arguably we all have a psychological contract with the State. We expect the State to look after us, to protect us whilst not intervening too much in our lives. When such unconscious perceptions are challenged as in the Little Ted Case the damage is likely to be long lasting and not helpful.

Many thanks to my film going friend who weekly updates me on what I should be going out to see. This week it was ‘The Soloist’, an interesting coincidence as the film is about friendship and trust. I am led to believe that it is a film about befriending, starting out with a simplistic view of friendship and going on to demonstrate the many subtle complexities involved when two very different lives come together. Like the psychological contract does the value of real friendship lie in its ability to provide a sense of containment that promotes mental well-being?

My mental health and well being has been severely challenged this week. So it was a surprise to find some light relief, and from such an unexpected quarter. Cello, a 10 week old Australian Labradoodle arrived this weekend – don’t ask - and has been a source of great joy.

Puppies, of course start from a position of unconditional positive regard, it’s humans that have the ability to change all that.